Abstract
Background. aim of this study was to compare the role of diagnostic laparoscopy and contrast enhanced computed tomography (CECT) of abdomen in the staging of stomach carcinoma. Methods. This was a prospective study conducted in a tertiary care hospital over a period of two years and included 50 patients of endoscopy and biopsy proven stomach carcinoma that were found to be operable on CECT. Diagnostic laparoscopy was performed in all patients before proceeding to a formal laparotomy. Results. Metastasis was detected at diagnostic laparoscopy in 14 (28%) patients. CECT correctly identified the T stage in 22 (61%) patients. Overall accuracy of CECT for T staging was 74% with a a sensitivity of 65% and a specificity of 79%. Laparoscopy correctly identified the T stage in 26 (72%) patients. Overall accuracy of laparoscopy for T staging was 81% with a sensitivity of 76% and specificity of 86%. the most common N stage on CECT was N0 (50%). CECT correctly identified the N stage in 26 (72%) patients. Overall accuracy of CECT for N staging was 86% with a sensitivity of 50% and a specificity of 90%. the most common N stage on laparoscopy was N0 and N2 (42% each). Laparoscopy correctly identified the N stage in 27 (75%) patients. Overall accuracy of Laparoscopy for N staging was 88% with a sensitivity of 53% and specificity of 91%. Conclusion. Laparoscopy is a valuable technique in staging of stomach carcinoma and has an important role in the detection of intra-abdominal metastasis missed by CECT.
Highlights
Gastric cancer remains one of the most common causes of death from cancer worldwide, especially in our part of the world
This was a prospective study conducted on 50 patients of endoscopic and biopsy proven stomach carcinoma that were found to be operable on contrast enhanced computed tomography (CECT) of abdomen/pelvis
Metastasis was detected at diagnostic laparoscopy in 14 (28%) patients
Summary
Gastric cancer remains one of the most common causes of death from cancer worldwide, especially in our part of the world. As the multidisciplinary management of gastrointestinal cancer has evolved over the last decade, an accurate extent of disease workup has become essential for treatment planning. Even after a thorough radiological workup, many patients with stomach carcinoma are diagnosed as unresectable or metastatic on exploratory laparotomy. Since the introduction of contrast enhanced computed tomography (CECT) scan some 30 years back, the staging workup of gastric carcinoma has underwent a boom [3,4,5]. CECT is used preoperatively primarily to determine the stage and extragastric spread of the carcinoma but has the propensity to underestimate the extent of disease, with small-volume metastatic disease being appreciated only at open surgical exploration. The aim of laparoscopic staging is to mimic staging at open exploration while minimizing morbidity, enhancing recovery, and allowing for quicker administration of adjuvant therapies if indicated [6,7,8]
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